Effect of Ebstein's anomaly on short- and long-term outcome of surgically treated patients with Wolff-Parkinson-White syndrome.

Abstract

BACKGROUND Ebstein's anomaly is the most commonly occurring congenital abnormality associated with the Wolff-Parkinson-White (WPW) syndrome. However, the effects of Ebstein's anomaly on the risks and benefits of surgical ablation of accessory pathways in patients with WPW syndrome are unknown. METHODS AND RESULTS This study compared the long-term outcome of 38 WPW patients with Ebstein's anomaly undergoing accessory pathway ablation to a reference population of 384 similarly treated patients without the anomaly. Ebstein's anomaly was mild in 21 patients (55%) and moderate-to-severe in 17 patients (45%). Sixteen patients (42%) required tricuspid valve surgery, and 23 (61%) had an atrial septal defect or patent foramen ovale repaired. Baseline clinical characteristics and preoperative clinical arrhythmias were similar in both groups. Ten-year survival was 92.4% and 91.2% for patients with and without Ebstein's anomaly, respectively (p = NS). During a mean follow-up of 6.2 +/- 3.8 and 5.3 +/- 3.6 years, 82% of patients with and 90% without Ebstein's anomaly had either clinically insignificant or no arrhythmias, and 18% versus 10% reported symptoms suggesting arrhythmias lasting longer than 1 minute, respectively. Atrial fibrillation was reduced postoperatively to 9% (p less than 0.001) in patients with and to 4% (p less than 0.001) in those without the anomaly. Fewer hospitalizations were reported postoperatively by 90% versus 96% of patients with and without Ebstein's anomaly; 9.4% versus 6.0% of patients were disabled at follow-up, respectively (p = NS). CONCLUSIONS Patients with Ebstein's anomaly are improved significantly after accessory pathway ablation. The presence of this anomaly should not preclude accessory pathway ablation in these patients.

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…330,333,334 This is less frequent if ablation is limited to pulmonary vein isolation. On the other hand, these arrhythmias Table 1; drugs listed alphabetically.…”

“…are more common in patients with longer-duration persistent AF or more dilated left atria or when linear ablation lesions are used. [333][334][335][336][337][338] Non-reentrant focal arrhythmias often originate at lesion edges or reconnected segments of prior isolated pulmonary veins. 333 Reisolation of the pulmonary vein and ablation of any nonpulmonary vein foci are often effective in treating these arrhythmias.…”

Individual quality of life in adults with congenital heart disease: a paradigm shift

“…To date, all published studies examining quality of life issues in adults with congenital heart disease have used the need approach. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In these studies, quality of life was measured from a functional or socioeconomic, rather than an individual, perspective. The former approach typically uses standardized questionnaires or classification systems.…”

Right Atrioventricular Valve Malformation in Dogs and Cats: An Electrocardiographic Survey With Emphasis on Splintered QRS Complexes

“…Although the mechanism underlying this splintering is currently unknown, potential causes of the alteration of ventricular depolarization include fibrosis, bypass tracts, and i~c h e m i a . '~-'~ Bypass tracts and fibrosis have been reported in human patients with EM, 15.1 8-20 Wolff-Parkinson-White syndrome is frequently associated with EM in humans, and ventricular pre-excitation via accessory atrioventricular pathways may alter QRS morphology." One cat in this study had some features of pre-excitation, with a short P-R interval and altered depolarization, but classic delta waves were not identified, and the QRS duration was normal.…”